title: Effects of gender and dementia severity on Alzheimer's disease caregivers' sleep and biomarkers of coagulation and inflammation.
abstract: BACKGROUND
  Being a caregiver for a spouse with Alzheimer's disease is associated with increased risk for cardiovascular illness, particularly for males. This study examined the effects of caregiver gender and severity of the spouse's dementia on sleep, coagulation, and inflammation in the caregiver.
  
  
  METHODS
  Eighty-one male and female spousal caregivers and 41 non-caregivers participated (mean age of all participants 70.2 years). Full-night polysomnography (PSG) was recorded in each participants home. Severity of the Alzheimer's disease patient's dementia was determined by the Clinical Dementia Rating (CDR) scale. The Role Overload scale was completed as an assessment of caregiving stress. Blood was drawn to assess circulating levels of D-dimer and Interleukin-6 (IL-6).
  
  
  RESULTS
  Male caregivers who were caring for a spouse with moderate to severe dementia spent significantly more time awake after sleep onset than female caregivers caring for spouses with moderate to severe dementia (p=.011), who spent a similar amount of time awake after sleep onset to caregivers of low dementia spouses and to non-caregivers. Similarly, male caregivers caring for spouses with worse dementia had significantly higher circulating levels of D-dimer (p=.034) than females caring for spouses with worse dementia. In multiple regression analysis (adjusted R(2)=.270, p<.001), elevated D-dimer levels were predicted by a combination of the CDR rating of the patient (p=.047) as well as greater time awake after sleep onset (p=.046).
  
  
  CONCLUSIONS
  The findings suggest that males caring for spouses with more severe dementia experience more disturbed sleep and have greater coagulation, the latter being associated with the disturbed sleep. These findings may provide insight into why male caregivers of spouses with Alzheimer's disease are at increased risk for illness, particularly cardiovascular disease.
authors.affiliation: Department of Psychiatry, University of California at San Diego, La Jolla, CA, USA. pmills@ucsd.edu
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Mills
authors.forename: Sonia
authors.initials: S
authors.lastname: Ancoli-Israel
authors.forename: Roland
authors.initials: R
authors.lastname: von Känel
authors.forename: Brent T
authors.initials: BT
authors.lastname: Mausbach
authors.forename: Kirstin
authors.initials: K
authors.lastname: Aschbacher
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Patterson
authors.forename: Michael G
authors.initials: MG
authors.lastname: Ziegler
authors.forename: Joel E
authors.initials: JE
authors.lastname: Dimsdale
authors.forename: Igor
authors.initials: I
authors.lastname: Grant
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease; D015415:Biomarkers; D001777:Blood Coagulation / Q000502:physiology*; D017028:Caregivers / Q000523:psychology*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000503:physiopathology / Q000523:psychology; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D012306:Risk; D012720:Severity of Illness Index; D012727:Sex Characteristics; D012890:Sleep / Q000502:physiology*; D007319:Sleep Initiation and Maintenance Disorders / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D018454:Spouses / Q000523:psychology; D019851:Thrombophilia / Q000097:blood / Q000209:etiology* / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C508600:IL6 protein, human; D015850:Interleukin-6; C036309:fibrin fragment D